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Original Article

Effects of Non-pharmacological Interventions on Primary Insomnia in Adults Aged 55 and Above: A Meta-analysis

Ji Hyun Kim1, Pok Ja Oh2
Korean Journal of Adult Nursing 2016;28(1):13-29.
Published online: February 29, 2016

1Graduate School, College of Nursing, Korea University, Seoul

2Department of Nursing, Sahmyook University, Seoul, Korea

Corresponding author: Oh, Pok-Ja Department of Nursing, Sahmyook University, 815 Kongnung-dong, Hwarang-ro, Nowon-gu. Seoul 01795, Korea. Tel: +82-2-3399-1589, Fax: +82-2-3399-1594, E-mail: ohpj@syu.ac.kr
• Received: October 1, 2015   • Accepted: February 12, 2016

Copyright © 2016 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    This study was performed to evaluate the effects of non-pharmacological interventions on sleep disturbance amongst adults aged 55 and above.
  • Methods
    PubMed, Cochrane Library, EMBASE, CINAHL and several Korean databases were searched. The main search strategy combined terms including non-pharmacological interventions and presence of insomnia. Non-pharmacological interventions included cognitive behavioral therapy, auricular acupuncture, aromatherapy, and emotional freedom techniques. Methodological quality was assessed using Cochrane's Risk of Bias for randomized studies and Risk of Bias Assessment tool for non randomized studies. Data were analyzed by the RevMan 5.3 program of Cochrane Library.
  • Results
    Sixteen clinical trials met the inclusion criteria with a total of 962 participants. Non-pharmacological interventions was conducted for a mean of 5.5 weeks, 7.7 sessions, and an average of 70 minutes per session. The effects of non-pharmacological interventions on sleep quality (ES=-1.18), sleep efficiency (ES=-1.14), sleep onset latency (ES=-0.88), awakening time after sleep onset (ES=-0.87), and sleep belief (ES=-0.71) were significant, and their effect sizes were ranged from moderate to large. However, the effects on total sleep time and insomnia severity were not significant.
  • Conclusion
    The findings of the current study suggest that non-pharmacological interventions have a positive impact on attitudes and beliefs about sleep, sleep quality, sleep duration, and sleep efficiency. Therefore, the findings of the study provide an evidence to incorporate various non-pharmacological interventions into nursing practice to improve both sleep quality and quantity in patients with insomnia.
  • Key Words: Sleep initiation and maintenance disorders; Intervention studies; Aged; Meta-analysis
Figure 1.
Flow of studies included from database search.
kjan-28-13f1.jpg
Figure 2.
Forest plot of effect size and 95% CI by non-pharmacological interventions on sleep onset latency, wake after sleep onset (WASO), and sleep efficiency.
kjan-28-13f2.jpg
Figure 3.
Forest plot of effect size and 95% CI by non-pharmacological interventions on sleep quality and sleep belief.
kjan-28-13f3.jpg
Table 1.
Descriptive Summary of the Included Studies (N=16)
Study Country Patient Design Mean age Sample size Intervention Control group Outcomes (Scale)
Name Format (setting) Provider Duration/ No. of session Min/ session
1. Buysse et al (2011) USA Chronic insomnia and comorn comorbidities RCT Exp. (72.5) Cont. (70.8) Exp. (39) Cont. (40) BBTI (brief behavioral treatment for insomnia) Individual (unclear) Nurse clinician 2 wks/ 2+2 telephone calls 45~60+ 20-minute telephone calls later and after 1, 3 wks Information control (read publication s and 10-minute telephone calls) 1) Neuropsychiatric status
- Depression (Hamilton Rating Scale for Depression)
- Anxiety (Hamilton Anxiety Rating Scale)
2) Subjective sleep quality (PSQI / ESS)
3) Health related quality of life (SF-36)
4) sleep (The pittsburgh sleep diary)
5) Wrist actigraphy data
6) PSG
2. Haimov & Shatil (2013) USA Chronic insomnia RCT Exp. (73.2) Cont. (69.9) Exp. (34) Cont. (17) CogniFit (cognitive training program) Individual (home) Computer-based personalized 8 wks/ 24 20~30 Active control (software program, "Word and Paint") 1) Sleep quality
- SOL, SE, TST, WASO, Actigraphy
2) Cognitive performance (AM, DA, DS, GC, GM, IN, NM, PL, RT, SH, SP, TE, VM, VP, VS, WM)
3. Hong (2008) Republic of Korea Elderly with insomnia Non-RCT Exp. (67.9) Cont. (70.7) Exp. (16) Cont. (16) Sleep management training (sleep hygiene & progressive muscle relaxation) Group (unclear) Researcher & assistants 4 wks/ 4 60+30 Home-work No treatment 1) Sleep score
2) Sleep-satisfaction score (VAS)
3) Partial immune response (T3 (CD3), T4 (CD4), B cell (CD19))
4. Irwin et al (2014) USA Chronic and primary insomnia RCT Exp. 1 (64.4) Exp. 2 (66.3) Cont. (66.4) Exp. 1 (50) Exp. 2 (48) Cont. (25) Exp. 1: CBT Exp. 2: TCC (tai chi chih) Group (unclear) Therapist 12 wks/ 12 120 Sleep seminar education control 1) Patient reported outcomes of insomnia symptom severity and sleep quality
- Sleep Quality, TST, SL, SE, WASO (PSQI/AIS/Sleep Diary/PSG)
2) Additional behavioral outcomes
- Fatigue (MDFSI)
- Sleepiness (ESS)
- Depressive symptom (IDS-C)
3) CRP levels
5. Lee & Kwon (2009) Republic of Korea Elderly with sleep disorder on-RCT Exp. (74.5) Cont. (69.4) Exp. (23) Cont. (20) Auriculotherapy Individual (community senior centers s) Researcher & assistants 4 wks/ 4 Unclear No treatment 1) Sleep scale score
2) Sleep satisfaction
6. Lee (2011) Republic of Korea Institutionalize d elderly Non-RCT Exp. (74.1) Cont. (73.5) Exp. (20) Cont. (22) Aromatherapy hand massage program Individual (hospital) Researcher & assistants 2 wks/ 10 10 No treatment 1) Anxiety scale
2) Depression scale 3) Sleep disturbance scale
3) Sleep disturbance scale
4) Fatigue scale
7. Lee (2013) Republic of Korea Elderly with insomnia RCT Exp. (79.67) Cont. (76.07) Exp. (15) Cont. (15) EFT-I (emotional freedom techniques) Group (hospital) EFT instructor 4 wks/ 8 60 Sleep hygiene education 1) Korean sleep scale
2) Sleep quality (PSQI)
3) Depression (GDS-K)
4) State-Trait Anxiety (STAI)
5) life satisfaction scale
8. Lichstein et al (2001) USA Late-life insomnia RCT Exp. 1 (68.11) Exp. 2 (67.92) Cont. (68.04) Exp. 1 (27) Exp. 2 (24) Cont. (23) Exp. 1: Relaxation Exp. 2: Sleep compression Individual (sleep disorders center) Therapists 6 wks/ 6 45 Usual care (placebo-quasi desensitization) (Sleep Diary, PSG)
1) Sleep latency
2) Number of awakening
- 3) WASO
4) TST
5) SE
6) Sleep quality rating
7) Napping
8) REM (%)
9) Fatigue (FSS)
10) Insomnia impact (IIS)
11) Epwoth sleep (ESS)
12) Beliefs and attitude about sleep (BASS)
9. Lovato et al (2014) Austrailia Sleep maintanance insomnia RCT 63.76 Exp. (86) Cont. (32) CBT-I Group (flinder university) Five trainee psychologists 4 wks/ 4 60 Waiting-list 1) Subjective sleep quality
- WASO, SE, Number of awakenings, SOL, TST, Bedtime, Lights-out time, Sleep onset time, Final wake-up time, Out-of-bed time, Time in bed
2) Objective sleep quality
- WASO, TST, SE (Actigraphy)
3) Reported severity of insomnia/ Daytime functioning/Confidence and beliefs about sleep
- ISI/FFS, ESS, Daytime feeling and functioning scale/sleep self-efficacy, DBAS, sleep anticipatory anxiety
10. Morgan et al (2012) UK Insomnia RCT Exp. (67) Cont. (66.3) Exp. (98) Cont. (95) Self-help CBT Individual (home) Trained advisors Unclear (6 self-help booklets & low-cost telephone helpline) Unclear Treatment as usual Primary outcome
1) Sleep Quality (PSQI)
Secondary outcome measures
1) Insomnia severity (ISI)
2) Subjective sleep efficiency (SE)
3) Fatigue (FSS)
4) Sleep medication use
11. Morin & Azrin (1988) Canada Geriatric insomnia (sleep-mainte nance insomnia) RCT Exp. 1 (68.4) Exp. 2 (67.5) Cont. (67.4) Exp. 1 (9) Exp. 2 (9) Cont. (10) Behavioral cognitive treatment (Exp. 1: Stimulus control, Exp. 2: Imagery training) ) Group (unclear) Therapists 5 wks/ 6 60~75 Waiting-list (Sleep Diary)
1) Awakening duration
2) Awakening frequency
3) Sleep-onset latency
4) TST
12. Morin et al (1993) USA Late-life insomnia RCT 67.1 Exp. 1 (12) Cont. (12) CBT Group (home) Clinical psychologist 8 wks/ unclear 90 Waiting-list 1) Sleep-onset latency
2) WASO
3) Early morning awakening
4) Total wake time
5) TST
6) SE
13. Morin et al (1999) Canada Late-life insomnia RCT Exp. 1 (64.4) Exp. 1 (18) Exp. 1: CBT Group (hospital-outpatients) Clinical psychologist or a postdoctoral fellow in clinical psychology 8 wks/ 8 90 Waiting-list (Sleep diary, PSG)
Exp. 2 (64.1) Exp. 2 (17) Exp. 2: PCT 1) WASO
Exp. 3 (65.2) Exp. 3 (19) Exp. 3: CBT+PCT 2) SE
Cont. (64.9) Cont. (18)   3) TST
14. Rybarczyk et al (2002) USA Comorbid geriatric insomnia RCT Exp. 1 (66.5) Exp. 1 (11) Exp. 1: CBT Group (unclear) Clinical gero-psychologists 6 wks/ 6 90 Treatment as usual 1) Sleep log measures
Exp. 2 (65.6) Exp. 2 (14) Exp. 2: Home based audio relaxation treatment (HART) 2) Actigraphy
Cont. (71.4) Cont. (13) 3) Sleep quality (PSQI)
4) Dysfunction beliefs and attitude (DBAS)
5) Geriatric depression scale (GDS)
6) BAI
7) Pain (SF-MPQ)
8) Life Satisfaction Index-Short Form
9) Quality of life (SF-36)
15. Rybarczyk et al (2005) USA Comorbid Insomnia RCT Exp. (70.1) Cont. (67.7) Exp. (46) Cont. (46) CBT Group (medical offices and senior centers) Clinical psychologists 8 wks/ 8 120 Stress manageme nt and wellness 1) Sleep log
2) Sleep quality (PSQI)
3) SII
4) Dysfunction beliefs and attitude (DBAS)
5) POMS
6) Geriatric depression scale (GDS)
(GDS) 7) Quality of life (SF-36)
8) Sickness impact profile (SIP)
8) Sickness impact profile (SIP) 9) Pain (SF-MPQ)
10) TEQ
16. Sok & Kim (2008) Republic of Korea a Insomnia of Taeumin in elderly women Non-RCT ≥65 Exp. (28) Auricular acupuncture therapy Individual (home, community welfare center, senior citizen center) Researcher 2 wks/ 4 Unclear Usual care (blood pressure) 1) Sleep score
Cont. (28) 2) Self-reported satisfaction (Visual Analogue Scale)

Exp.=experimental group; Cont.=control group; RCT=randomized controlled trials; Non-RCT=non-randomized controlled trial; PSQI=the pittsburgh sleep quality index; ESS=epworth sleepiness scale; SF-36=short form(36) health survey; PSG=polysomnography; SOL=sleep onset latency; SE=sleep efficiency; TST=total sleep time; WASO=wakefulness after sleep onset; NA=number of awakenings; AM=auditory memory; DA=divided attention; DS=avoiding distractions; GC=hand-eye co-ordination; GM=general memory; IN=inhibition; NM=naming; PL=planning; RT=response time; SH=shifting; SP=spatial perception; TE=time estimation; VM=visual working memory; VP=visual perception; VS=visual scanning; WM=working linguistic-auditory memory; VAS=visual analog scale; CBT=cognitive behavioral therapy; SL=sleep latency; AIS=athens insomnia scale; MDFSI=multidimensional fatigue severity index; IDS-C=inventory of depressive symptomatology-clinician rating scale; GDS-K=geriatric depression scale in Korea; STAI=state-trait anxiety inventory; FSS=fatigue severity scale; IIS=insomnia impact scale; BASS=belief and attitudes about sleep scale; ISI=insomnia severity inventory; FFS=flinders fatigue scale; DBAS=dysfunctional beliefs and attitudes about sleep scale; GDS=geriatric depression scale; BAI=beck anxiety inventory; SF-MPQ=short form mcgill pain questionnaire; SII=sleep impairment index; POMS=profile of mood states; SIP=sickness impact profile; ITEQ=insomnia treatment evaluation questionnaire.

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    Effects of Non-pharmacological Interventions on Primary Insomnia in Adults Aged 55 and Above: A Meta-analysis
    Korean J Adult Nurs. 2016;28(1):13-29.   Published online February 29, 2016
    DOI: https://doi.org/10.7475/kjan.2016.28.1.13
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    Effects of Non-pharmacological Interventions on Primary Insomnia in Adults Aged 55 and Above: A Meta-analysis
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    DOI: https://doi.org/10.7475/kjan.2016.28.1.13
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    Effects of Non-pharmacological Interventions on Primary Insomnia in Adults Aged 55 and Above: A Meta-analysis
    Image Image Image
    Figure 1. Flow of studies included from database search.
    Figure 2. Forest plot of effect size and 95% CI by non-pharmacological interventions on sleep onset latency, wake after sleep onset (WASO), and sleep efficiency.
    Figure 3. Forest plot of effect size and 95% CI by non-pharmacological interventions on sleep quality and sleep belief.

    Figure 1.

    Figure 2.

    Figure 3.

    Effects of Non-pharmacological Interventions on Primary Insomnia in Adults Aged 55 and Above: A Meta-analysis

    Descriptive Summary of the Included Studies (N=16)

    Study Country Patient Design Mean age Sample size Intervention Control group Outcomes (Scale)
    Name Format (setting) Provider Duration/ No. of session Min/ session
    1. Buysse et al (2011) USA Chronic insomnia and comorn comorbidities RCT Exp. (72.5) Cont. (70.8) Exp. (39) Cont. (40) BBTI (brief behavioral treatment for insomnia) Individual (unclear) Nurse clinician 2 wks/ 2+2 telephone calls 45~60+ 20-minute telephone calls later and after 1, 3 wks Information control (read publication s and 10-minute telephone calls) 1) Neuropsychiatric status
    - Depression (Hamilton Rating Scale for Depression)
    - Anxiety (Hamilton Anxiety Rating Scale)
    2) Subjective sleep quality (PSQI / ESS)
    3) Health related quality of life (SF-36)
    4) sleep (The pittsburgh sleep diary)
    5) Wrist actigraphy data
    6) PSG
    2. Haimov & Shatil (2013) USA Chronic insomnia RCT Exp. (73.2) Cont. (69.9) Exp. (34) Cont. (17) CogniFit (cognitive training program) Individual (home) Computer-based personalized 8 wks/ 24 20~30 Active control (software program, "Word and Paint") 1) Sleep quality
    - SOL, SE, TST, WASO, Actigraphy
    2) Cognitive performance (AM, DA, DS, GC, GM, IN, NM, PL, RT, SH, SP, TE, VM, VP, VS, WM)
    3. Hong (2008) Republic of Korea Elderly with insomnia Non-RCT Exp. (67.9) Cont. (70.7) Exp. (16) Cont. (16) Sleep management training (sleep hygiene & progressive muscle relaxation) Group (unclear) Researcher & assistants 4 wks/ 4 60+30 Home-work No treatment 1) Sleep score
    2) Sleep-satisfaction score (VAS)
    3) Partial immune response (T3 (CD3), T4 (CD4), B cell (CD19))
    4. Irwin et al (2014) USA Chronic and primary insomnia RCT Exp. 1 (64.4) Exp. 2 (66.3) Cont. (66.4) Exp. 1 (50) Exp. 2 (48) Cont. (25) Exp. 1: CBT Exp. 2: TCC (tai chi chih) Group (unclear) Therapist 12 wks/ 12 120 Sleep seminar education control 1) Patient reported outcomes of insomnia symptom severity and sleep quality
    - Sleep Quality, TST, SL, SE, WASO (PSQI/AIS/Sleep Diary/PSG)
    2) Additional behavioral outcomes
    - Fatigue (MDFSI)
    - Sleepiness (ESS)
    - Depressive symptom (IDS-C)
    3) CRP levels
    5. Lee & Kwon (2009) Republic of Korea Elderly with sleep disorder on-RCT Exp. (74.5) Cont. (69.4) Exp. (23) Cont. (20) Auriculotherapy Individual (community senior centers s) Researcher & assistants 4 wks/ 4 Unclear No treatment 1) Sleep scale score
    2) Sleep satisfaction
    6. Lee (2011) Republic of Korea Institutionalize d elderly Non-RCT Exp. (74.1) Cont. (73.5) Exp. (20) Cont. (22) Aromatherapy hand massage program Individual (hospital) Researcher & assistants 2 wks/ 10 10 No treatment 1) Anxiety scale
    2) Depression scale 3) Sleep disturbance scale
    3) Sleep disturbance scale
    4) Fatigue scale
    7. Lee (2013) Republic of Korea Elderly with insomnia RCT Exp. (79.67) Cont. (76.07) Exp. (15) Cont. (15) EFT-I (emotional freedom techniques) Group (hospital) EFT instructor 4 wks/ 8 60 Sleep hygiene education 1) Korean sleep scale
    2) Sleep quality (PSQI)
    3) Depression (GDS-K)
    4) State-Trait Anxiety (STAI)
    5) life satisfaction scale
    8. Lichstein et al (2001) USA Late-life insomnia RCT Exp. 1 (68.11) Exp. 2 (67.92) Cont. (68.04) Exp. 1 (27) Exp. 2 (24) Cont. (23) Exp. 1: Relaxation Exp. 2: Sleep compression Individual (sleep disorders center) Therapists 6 wks/ 6 45 Usual care (placebo-quasi desensitization) (Sleep Diary, PSG)
    1) Sleep latency
    2) Number of awakening
    - 3) WASO
    4) TST
    5) SE
    6) Sleep quality rating
    7) Napping
    8) REM (%)
    9) Fatigue (FSS)
    10) Insomnia impact (IIS)
    11) Epwoth sleep (ESS)
    12) Beliefs and attitude about sleep (BASS)
    9. Lovato et al (2014) Austrailia Sleep maintanance insomnia RCT 63.76 Exp. (86) Cont. (32) CBT-I Group (flinder university) Five trainee psychologists 4 wks/ 4 60 Waiting-list 1) Subjective sleep quality
    - WASO, SE, Number of awakenings, SOL, TST, Bedtime, Lights-out time, Sleep onset time, Final wake-up time, Out-of-bed time, Time in bed
    2) Objective sleep quality
    - WASO, TST, SE (Actigraphy)
    3) Reported severity of insomnia/ Daytime functioning/Confidence and beliefs about sleep
    - ISI/FFS, ESS, Daytime feeling and functioning scale/sleep self-efficacy, DBAS, sleep anticipatory anxiety
    10. Morgan et al (2012) UK Insomnia RCT Exp. (67) Cont. (66.3) Exp. (98) Cont. (95) Self-help CBT Individual (home) Trained advisors Unclear (6 self-help booklets & low-cost telephone helpline) Unclear Treatment as usual Primary outcome
    1) Sleep Quality (PSQI)
    Secondary outcome measures
    1) Insomnia severity (ISI)
    2) Subjective sleep efficiency (SE)
    3) Fatigue (FSS)
    4) Sleep medication use
    11. Morin & Azrin (1988) Canada Geriatric insomnia (sleep-mainte nance insomnia) RCT Exp. 1 (68.4) Exp. 2 (67.5) Cont. (67.4) Exp. 1 (9) Exp. 2 (9) Cont. (10) Behavioral cognitive treatment (Exp. 1: Stimulus control, Exp. 2: Imagery training) ) Group (unclear) Therapists 5 wks/ 6 60~75 Waiting-list (Sleep Diary)
    1) Awakening duration
    2) Awakening frequency
    3) Sleep-onset latency
    4) TST
    12. Morin et al (1993) USA Late-life insomnia RCT 67.1 Exp. 1 (12) Cont. (12) CBT Group (home) Clinical psychologist 8 wks/ unclear 90 Waiting-list 1) Sleep-onset latency
    2) WASO
    3) Early morning awakening
    4) Total wake time
    5) TST
    6) SE
    13. Morin et al (1999) Canada Late-life insomnia RCT Exp. 1 (64.4) Exp. 1 (18) Exp. 1: CBT Group (hospital-outpatients) Clinical psychologist or a postdoctoral fellow in clinical psychology 8 wks/ 8 90 Waiting-list (Sleep diary, PSG)
    Exp. 2 (64.1) Exp. 2 (17) Exp. 2: PCT 1) WASO
    Exp. 3 (65.2) Exp. 3 (19) Exp. 3: CBT+PCT 2) SE
    Cont. (64.9) Cont. (18)   3) TST
    14. Rybarczyk et al (2002) USA Comorbid geriatric insomnia RCT Exp. 1 (66.5) Exp. 1 (11) Exp. 1: CBT Group (unclear) Clinical gero-psychologists 6 wks/ 6 90 Treatment as usual 1) Sleep log measures
    Exp. 2 (65.6) Exp. 2 (14) Exp. 2: Home based audio relaxation treatment (HART) 2) Actigraphy
    Cont. (71.4) Cont. (13) 3) Sleep quality (PSQI)
    4) Dysfunction beliefs and attitude (DBAS)
    5) Geriatric depression scale (GDS)
    6) BAI
    7) Pain (SF-MPQ)
    8) Life Satisfaction Index-Short Form
    9) Quality of life (SF-36)
    15. Rybarczyk et al (2005) USA Comorbid Insomnia RCT Exp. (70.1) Cont. (67.7) Exp. (46) Cont. (46) CBT Group (medical offices and senior centers) Clinical psychologists 8 wks/ 8 120 Stress manageme nt and wellness 1) Sleep log
    2) Sleep quality (PSQI)
    3) SII
    4) Dysfunction beliefs and attitude (DBAS)
    5) POMS
    6) Geriatric depression scale (GDS)
    (GDS) 7) Quality of life (SF-36)
    8) Sickness impact profile (SIP)
    8) Sickness impact profile (SIP) 9) Pain (SF-MPQ)
    10) TEQ
    16. Sok & Kim (2008) Republic of Korea a Insomnia of Taeumin in elderly women Non-RCT ≥65 Exp. (28) Auricular acupuncture therapy Individual (home, community welfare center, senior citizen center) Researcher 2 wks/ 4 Unclear Usual care (blood pressure) 1) Sleep score
    Cont. (28) 2) Self-reported satisfaction (Visual Analogue Scale)

    Exp.=experimental group; Cont.=control group; RCT=randomized controlled trials; Non-RCT=non-randomized controlled trial; PSQI=the pittsburgh sleep quality index; ESS=epworth sleepiness scale; SF-36=short form(36) health survey; PSG=polysomnography; SOL=sleep onset latency; SE=sleep efficiency; TST=total sleep time; WASO=wakefulness after sleep onset; NA=number of awakenings; AM=auditory memory; DA=divided attention; DS=avoiding distractions; GC=hand-eye co-ordination; GM=general memory; IN=inhibition; NM=naming; PL=planning; RT=response time; SH=shifting; SP=spatial perception; TE=time estimation; VM=visual working memory; VP=visual perception; VS=visual scanning; WM=working linguistic-auditory memory; VAS=visual analog scale; CBT=cognitive behavioral therapy; SL=sleep latency; AIS=athens insomnia scale; MDFSI=multidimensional fatigue severity index; IDS-C=inventory of depressive symptomatology-clinician rating scale; GDS-K=geriatric depression scale in Korea; STAI=state-trait anxiety inventory; FSS=fatigue severity scale; IIS=insomnia impact scale; BASS=belief and attitudes about sleep scale; ISI=insomnia severity inventory; FFS=flinders fatigue scale; DBAS=dysfunctional beliefs and attitudes about sleep scale; GDS=geriatric depression scale; BAI=beck anxiety inventory; SF-MPQ=short form mcgill pain questionnaire; SII=sleep impairment index; POMS=profile of mood states; SIP=sickness impact profile; ITEQ=insomnia treatment evaluation questionnaire.
    Table 1. Descriptive Summary of the Included Studies (N=16)

    Exp.=experimental group; Cont.=control group; RCT=randomized controlled trials; Non-RCT=non-randomized controlled trial; PSQI=the pittsburgh sleep quality index; ESS=epworth sleepiness scale; SF-36=short form(36) health survey; PSG=polysomnography; SOL=sleep onset latency; SE=sleep efficiency; TST=total sleep time; WASO=wakefulness after sleep onset; NA=number of awakenings; AM=auditory memory; DA=divided attention; DS=avoiding distractions; GC=hand-eye co-ordination; GM=general memory; IN=inhibition; NM=naming; PL=planning; RT=response time; SH=shifting; SP=spatial perception; TE=time estimation; VM=visual working memory; VP=visual perception; VS=visual scanning; WM=working linguistic-auditory memory; VAS=visual analog scale; CBT=cognitive behavioral therapy; SL=sleep latency; AIS=athens insomnia scale; MDFSI=multidimensional fatigue severity index; IDS-C=inventory of depressive symptomatology-clinician rating scale; GDS-K=geriatric depression scale in Korea; STAI=state-trait anxiety inventory; FSS=fatigue severity scale; IIS=insomnia impact scale; BASS=belief and attitudes about sleep scale; ISI=insomnia severity inventory; FFS=flinders fatigue scale; DBAS=dysfunctional beliefs and attitudes about sleep scale; GDS=geriatric depression scale; BAI=beck anxiety inventory; SF-MPQ=short form mcgill pain questionnaire; SII=sleep impairment index; POMS=profile of mood states; SIP=sickness impact profile; ITEQ=insomnia treatment evaluation questionnaire.

    Table 1.

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